Unlocking the Secrets: The Hidden Truth about Fracture Management

Broken a bone?

It is common knowledge that following fracture are placed in a cast (or immobilisation device like a boot, splint or sling) and left for 6 weeks or more for the bone to heal.

But is that the best and only management?

Bone certainly needs time to heal following fracture and immobilisation is often required in many cases.

Following this 6 week time period, your doctor or specialist will usually order another X-ray and your cleared to come out of the cast.

Yay, you’re on your way back to normal life!

Wrong!

During a period of immobilisation, many other things also occur that are often over looked and create more problems!

In this blog I am going to show you 4 things that are often not considered during or following breaking a bone!

This blog will explore:

What is a fracture and how is it diagnosed?
What happens during a fracture for bone to heal?
What else is lost while we wait for bone to heal?
How can we do better with post fracture management so long term issues don’t exist!

Let’s jump into it!

What is a fracture and how is it diagnosed?

A fracture is a common bone injury suffered by most humans at some point in their lifetime.

Causes of bone fractures include trauma, overuse and diseases that weaken the bones, such as osteoporosis.

The main symptom of a fracture is pain. However, also commonly results in anything from a mild to severe loss of function depending on the affected area and severity of fracture.

A fracture is commonly diagnosed using an X-ray but can also be found on a CT-scan or MRI.

Once a fracture is found, it is then categorised depending on a few variables such as the position of the ends of the bone, the completeness of the break, and the orientation of the fracture.

Depending on these factors, a decision will be made as to whether surgery is required to re-align any of the bones or help to make the fracture site stable.

If no surgery is required, the next step of the management is to immobilise the fracture site to allow time for bone healing to occur.

A fracture is usually immobilised using plaster of paris casting, a sling or a fixed orthosis.

Most fractures will heal in 6 weeks to a point that they no longer need to be immobilised.

This timeline can vary tremendously from bone to bone and in each person based on a variety of factors.

Sometimes this creates a perfect storm leading to mal-union or non-union of bone resulting in extended healing times of many, many months.

What happens during immobilisation for broken bone?

The different stages of bone healing explained!

0-2 weeks = Hematoma Formation

2-3 weeks = Soft Callus formation

3-6 weeks = Hard Callus Formation

8 weeks – 2 years = Bone Remodelling occurs

What no one talks about or explains to you when you are in a cast!

There are many things that occur that are often over looked during acute fracture management.

These create secondary issues long term that resulting loss of function, lack of performance in everyday activities or sport.

In some cases, a limb that just isn’t the same again despite being told everything is healed!

We need to consider the below more carefully when treating a fracture.

The loss of movement & stiffness after a broken bone

Due to the prolonged period of immobilisation following a fracture the joints and soft tissues surrounding the fracture site will often become tight and stiff.

This results in a loss of range of movement, either directly in the area of fracture or areas above or below it. Often impacting a persons normal movement and function.

It is therefore vital that this is regained as soon as possible after the period of immobilisation to allow you to return to pre-injury function.

If you don’t, expect prolonged stiffness and possibly loss of long-term function!

What should be done!

If you experience a loss in range of movement following fracture and immobilisation, you should be assessed by a physiotherapist.

We can compare the impact of this fracture either to the non-injured limb or compare it to normative values.

There is a variety of treatments that our physiotherapists use to help regain full movement post fracture.

These include

joint mobilisations to reduce stiffness and restore normal joint function
soft tissue massage to improve tissue length and feelings of tightness
passive stretching to lengthen and reduce muscle tightness
active stretching to return normal movement patterns and optimise tissue mobility

Muscle Atrophy

This is a fancy word for losing muscle.

Due to the inability to use the muscles surrounding the fracture while being immobilised, muscle shrinks and is lost due to dis-use!

Yep, that’s the shrivelled up limb your left with coming out of the cast!

What you might not be aware of is this leaves you with a significant strength deficit which results in an inability to perform movements the same as you could prior to the fracture.

A big muscle is a strong muscle.

But muscle hypertrophy takes time, in fact many many months to rebuild and grow back if it is stimulated correctly.

Where appropriate post fracture management is not advised, a size deficit in the muscles around the limb and surrounding joints will be noticeable for months, even years following fracture.

This leaves you exposed for future problems, injury and pain.

It is therefore important that a specific graded strengthening programme is started immediately following immobilisation to help rebuild the lost muscle and strength.

Not only will this allow you to return to full function faster but it will help to prevent further soft tissue injuries, but also reduces your risk of future fracture as strength training build strong bones!

At fighting fit we make use of the most up to date technology allowing us to accurately measure muscle strength and power.

This allows us to identify deficits and therefore allowing us to be very specific when selecting exercise and what muscles to target. That save time and effort by putting it to best use!

Testing and monitoring grip strength post wrist fracture ensures the hand and forearm strength is returned.

Loss of Proprioception

Proprioception is your body’s ability to sense movement and the bodies position in space.

Priprioception is required in every movement you make so when joints and limbs aren’t moved, proprioception will be lost.

After the 6-8 week period of immobilisation, proprioception is greatly reduced leaving your joints susceptible to injury due to the lack of stability and control.

Proprioception, like muscle strength, can be improved through training and is a vital component of rehab following a period of immobilisation following fracture.

Proprioception can be tested and measured, allowing us to give a clear training plan of how to improve it and help individuals return to full function.

Using a range of tools to measure and test proprioception, we can determine weight distribution of the lower limb. This allows us to provide patients with accurate and tailored programmes to help return to full function effectively post fracture.

Fighting Fit uses 3D kinematic soft ware totes and measure proprioception post injury.

How can we do better?

Physiotherapy after fracture

We have a manta at Fighting Fit.

“There is always something you can do, you just have to find it and do it!”

When it comes to fracture management we firmly believe that early intervention is critical to positive long term outcomes.

Even though a limb or part of the body is immobilised, we must consider the rest of the body.

Don’t immobilise the whole body, rest and waste away.

There is always the other side, joints and muscles above and below that can be exercised once pain settles and the healing fracture is somewhat stable (3-6weeks).

Did you know that training the opposite (or unaffected side) promotes a positive effect on the affect side?

Contra-lateral training is a great tool for getting in and started on rehab early.

“Early intervention saves weeks or months of hard work, pain and frustration later on!”

Also maintaining health with cardiovascular exercise promotes a good healthy environment for the body to heal.

If your leg is out of action, use an arm crank, ski erg, sit on the rower without the legs, there is always something you can do!

Don’t just sit and wait!

If you’ve suffered a new fracture or are struggling to get back to your previous function following a recent or old fracture then get in touch HERE.

Are you interested in exploring other services? We also provide exercise physiotherapy in Gold Coast. We would love to help you get back Fighting Fit!

Dean Phelps

Dean is a registered Gold Coast Physiotherapist with undergraduate and postgraduate studies in Human Movement and Exercise Science. His background has developed his vision for Fighting Fit Physiotherapy to focus on optimal health and peak physical performance for every single patient. Utilising his many qualifications, in depth knowledge of the body and passion for exercise he can provide a holistic approach to your treatment and exercise prescription to get the best outcome.

Brenda Samosa

05:52 07 Nov 24

I had a really bad shoulder and had been seeing a different physio for 3 months (from a different place) I got told Tyson was good. After just a few sessions the movement was coming back. I’m 66 and was worried I would have to stop surfing. But with a lot of help from Tyson I’m back in the waves ( thank you so so much)

Cyana Ferguson

08:16 30 Oct 24

Steve Harris

22:33 15 Oct 24

Great team, all friendly, super helpful and first class clinical advice and a big shout out to my Physio Noah with my shoulder issue

Andrea Bell

05:33 19 Sep 24

These guys are the best in the biz 🎉

Ryan Brockett

04:20 18 Sep 24

Shout out to Max from fighting fit physio. He helped me out massively straight after shoulder surgery and back into work and sports in no time. Couldn’t recommend anyone better!

Scotty

08:31 31 Jul 24

Five star service from Max & the team!
Professional & very thorough, you know that patient outcomes are of the highest priority.
I highly recommend this business.

Riley Wilson

08:27 14 Jul 24

Be AWARE they’ll immediately try to commit you to multiple follow up sessions after your initial consultation. This happened to me and then I later found out that as it just so happens, they have a cancellation policy that says you have to pay 100% of the consultation fee for cancelling. They failed to tell me this when they were pushy in committing me to 6 sessions after my consult, so that was a really nice little surprise.

I was already uncomfortable with how pushy they were in having me commit to so many sessions, so when I heard about the policy I just cancelled all together. So, I can’t speak further to the quality of their service throughout therapy phase. FYI this was also a few months ago now, it’s possible (though unlikely) they may have changed the policy. Just ask the question.

Megan Shelley

06:51 03 May 24

Fighting Fit Physiotherapy is hands down the best physio I've encountered. Having tried multiple physios for various injuries, I always find myself coming back to them. Their expertise consistently exceeds expectations, helping me get back to my sport faster than I thought possible. Their personalized approach and attention to detail make all the difference. I could not recommend a better or more exceptional physio team!

Gina Matthews

08:41 24 Mar 23

Can't recommend this place high enough. I was in so much pain with my knee an had been for months through advise an exercises I'm now looking forward to returning to gym an back riding my horses in endurance thank you so much

Courtney Halse

01:36 29 Nov 22

Kyle was knowledgeable, personable and professional. He saw me through my second pregnancy and continued to work with me until 6 months post partum on issues with my back. Would recommend anyone to go and see him.

Also shout out to Georgia on the front desk. She makes you feel welcome and brings a sense of warmth to the place!

Alli Davenport

08:07 04 Nov 22

After hip replacement surgery in February I wanted toget back into weight training legs, I started with Mitch 18 weeks ago and after a lot of hard work and sweat I am able to safely train again, I cannot thank Mitch enough for his support,encouragement and knowledge. The staff are friendly and helpful and I always looked forward to my session's

Robert Parkinson

10:50 15 Aug 22

This is the second time I have been treated by the team at FFP.
As a health professional myself I have been impressed with the level of care I have received from all members of the team.
The personalised treatment and rehabilitation programs have produced excellent results and I have completed both programs pain free and feeling stronger than before my injuries.
During the program there was constant communication and follow up and they were very accommodating with my work schedule.
All in all it was a very holistic experience and I would highly recommend the service.

Kiri Canavan

07:30 08 Jun 22

Tyson was amazing! We came up with an 8 week plan at my first consultation with weekly check ins and updates to exercises. 8 weeks later, I am pain free and able to train harder than ever. Highly recommend and the staff are all fantastic and super accomodating!

Broken a bone?

But is that the best and only management?

What is a fracture and how is it diagnosed?

What happens during immobilisation for broken bone?

What no one talks about or explains to you when you are in a cast!

The loss of movement & stiffness after a broken bone

Muscle Atrophy

Loss of Proprioception

How can we do better?

The Desk Worker’s Guide to a Pain-Free Neck

Hip Osteoarthritis: Why It Hurts and How Physio Can Help

The #1 Mistake Athletes Make After an Ankle Injury

The Secret to Beating Back Pain? Walk This Way!

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call 0402 938 661

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call 0402 938 661

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